Physiologic Disabilities

Common Problems&

Interventions

COMMON PROBLEMS

Five major problems :

1. PAIN2. STIFFNESS3. DECREASE IN MUSCLE

STRENGTH4. LOSS OF DEXTERITY5. LOSS OF LOCOMOTOR

ABILITY

PAIN

Pain is the priority problem.

STIFFNESS

Decreased flexibility Can be a result of pain, or of

disuse or it can be a result of pathophysiologic changes

DECREASE IN MUSCLE STRENGTH

a primary problems, as with some myopathic and neuropathic disorders, or it can result from prolonged bed rest or immobility

LOSS OF DEXTERITY

skilful use of hands or body

LOSS OF LOCOMOTOR ABILITY

Temporary or complete loss of the ability to move freely from one place to another or care for one’s self.

System Involved: Complications of

Immobility

CARDIOVASCULARMechanism:Failure of vessels in legs to

assume or maintain a state of vasoconstriction, resulting in pooling of venous blood.

Potential Complication:

Deep vein thrombosis (DVT)Pulmonary embolism (PE)Increase work load on heartDiminished cardiac outputDecreased ability to adapt to

erect posture

RESPIRATORY

Mechanism:Decrease movementDecrease stimulus to coughDecrease depth of

ventilation

Potential Complication:

Pooling of secretions in bronchi, bronchioles

Hypostatic pneumonia

SKINMechanism:Pressure or shearing forces

(two or more tissue layers sliding on each other or tissue sliding on another surface) disrupting or decreasing circulation to an area.

Potential Complication:

Skin breakdown (abrasion or decubitus ulcer)

GASTROINTESTINAL

Mechanism:Decrease bowel mobilityChange in dietary habitsDisadvantageous positioning for defecation

Potential Complication:

Constipation Impaction

MUSCULOSKELETAL MUSCLES

Mechanism:Disuse

Potential Complication:AtrophyWeakness

JOINTSMechanism:Limited motion leads to

muscle, tendon shortening

Potential Complication:ContractureFibrosis or bony ankylosis

around joints

BONESMechanism:Disruption of balance of

osteoblastic/osteoclstic activity with destruction of bone matrix and release of calcium.

Potential Complication:Osteoporosis

URINARYMechanism:Increase urinary pH,

increased citric acidPoor bladder emptyingPotential Complication:Renal stonesUrinary stasis

NEUROLOGIC

Mechanism:Loss of normal stimuli

Potential Complication:ConfusionRestlessnessForgetfulness

COMMON INTERVENTIONS

Common interventions:1. Rest, activity, joint protection,

energy conservation2. Assistive, supportive, and

safety devices3. Application of heat and cold4. Traction 5. Splinting and bracing

6. Positioning and transfer7. Exercise 8. Medications 9. Surgical interventions

Rest, activity, joint protection, energy conservationREST A therapeutic measure used in

many inflammatory and traumatic conditions of the musculoskeletal system.

However, too much rest can at times be as detrimental as too much activity.

Two Forms of Rest:

1. Absolute rest or no activity.2. Partial rest or limited

activity.

Nurse’s responsibility in helping the patient rest:

Help patient understand the meaning of “rest” as it applies to him or her.

Take over functions for the patient that would require use of body part beyond limits prescribed.

Teach the patient how to effectively use body parts not required to rest.

Gradually return functions to the patient when rest is no longer required.

ACTIVITY Activity, particularly in chronic

conditions, must be balanced with adequate rest.

Individuals who have pain with certain activities or increase pain and stiffness following certain activities must learn to recognize their tolerances and adapt their ADL accordingly.

• Nurses can help patients determine their activity needs in the following ways:

Teach the patient the advantages of continuing, but modifying, activity

Help the patient identify his or her own activity tolerances

Help the patient work out an activity schedule approximating rest/activity requirements at home.

Help the patient work through concerns about not being able to perform all activities he or she believes are necessary or desired.

Joint Protection & Energy Conservation

Individual with joint involvement and /or activity intolerances can learn to protect their joints and themselves from overuse, misuse, and stress by becoming aware of and practicing joint protection and energy conservation techniques.

Techniques:

Avoid positions of possible joint deformity

Avoid holding muscles or joints in one position for a long time

Use the strongest joints for all activities

Use joints in their best position, maintaining good standing and sitting posture

Conserve energy

Nursing Intervention:

Teach the patient to recognize the symptoms of overactivity.

Teach the patient appropriate energy conservation and joint protection techniques.

Encourage the patient to use those techniques in ADL.

Assistive, supportive, and safety devices Assistive devices

Viable for individuals who have impairement of upper and/or lower extremity function.

Some assistive devices for persons with motor impairments:

Supportive devices

Ambulatory aids Usually recommended for

persons who cannot bear weight on one or more joints of the lower extremities

•Some considerations regarding choice of device include:Axillary crutchesWalkersCanes

Safety devices

Enhance function and prevent accidents when normal function, balance, or dexterity are compromised.

Application of heat and coldHeat Used for relieving stiffness

and relaxing muscles and for analgesic effect and sedative effect.

Heat may be applied in a variety of ways:

Dry heatMoist heat

Cold Helpful in reducing or

preventing swelling, reducing pain, and relieving stiffness

Heat and cold should be applied with caution to any individual with decreased sensation, because that person will not be able to determine if damage is occurring.

Nursing intervention with heat and cold include:

Helping patient determine which type of application works best

Instructing patient about safety precautions to be observed with that method

Instructing patient about timely application of heat and cold depending on patient’s particular needs.

Assisting the patient with application.

Traction Used to help reduce contractures

or to relieve pain in the presence of muscle spasm.

It can be applied intermittently or constantly and usually in the form of skin traction, that is Buck’s extension, Russell traction, or pelvic traction.

Splinting and bracing

Purposes: Stabilize or support a joint Protect a joint or body part from external

trauma Mechanically correct dysfunction such

as footdrop by supporting the joint in its functional position

Assist patients to exercise specific joints

When patients need to use braces or splints, nurses need to:

Inspect patient’s skin after the orthosis has been applied for a short time to be certain it has caused no skin irritation

Notify orthotist if adjustments in the orthosis need to be madee to make it more comfortable or relieve chafing

Instruct the patient in the proper appllication and care of th eorthosis

Assist the patient to make the psychologic adjustment to wearing the orthosis

•Types of splints and braces and their function: Spring-loaded braces Oppose the action of unparalyzed

muscles and act as partial functional substitutes for paralyzed muscles

Resting splints Maintain a limb or joint in a functional

position while permitting the muscles around the joint to relax

Functional splints Maintain the joint or limb in a

usable position to enable the body part to be used correctly

Dynamic splints Permit assisted exercise to

joints, particularly following surgery to finger joints

Positioning and transfer

Exercise

Exercise is a prescribed form of activity designed to accomplish the following:

Preserve joint mobilityMaintain muscle toneStrengthen selected muscle

groups

Medications

antiinflammatory analgesicsTeach patients the expected

effects of the drugsHow to use them

appropriatelyHow to recognize side effects

or toxic effects.

Use of narcotic analgesics in chronic inflammatory musculoskeletal conditions is generally contraindicated.

Promoting nutrition important for individuals with musculoskeletal

problems for anyone else Patient should pay particular attention to

avoiding weight gain For many individuals with mobility problems,

however, the problem of weight and mobility becomes a vicious circle.

This cycle can be broken only by weight loss through a properly supervised reduction diet.

Nurses can help in the following ways: Teach patient the importance of a well-

balanced diet Teach patients the importance of restricting

weight gain Encourage patients to select food wisely Encourage the patient family to bring home

cooked food if the patient is not eating hospital food particularly following surgery when the patient needs to maintain a positive nitrogen balance

Surgical interventions

Indication period: Two categories: Those who have suffered trauma such

as a fracture Those who require an elective

orthopaedic procedure for correction of deformity, relief of pain, or restoration of musculoskeletal function .

•Four major objectives of orthopaedic treatment:1. Restoration or maintenance of function

of a body part

2. Prevention of deformity

3. Correction of deformity if it already exists

4. Development of the patient’s powers of compensation and adaptation if loss of function or permanent deformity is not preventable

It is important that those caring for the patient know and understand what the expected outcomes are so that care may be adapted to achieving them.

Types of surgery:

Arthrotomy

=opening of a joint

• Arthroplasty=reconstruction of a joint

Synovectomy=removal of part or all of the synovial membrane

• Osteotomy =cutting a bone to change its alignment

Arthrodesis=causing the bones of a joint to grow together by removing articular hyaline cartilage, introducing bone grafts, and stabilizing with external fixation

• Tendon transplants=moving a tendon from its usual position